Patient Advocate Services

We offer patient advocate services, because we understand how much it can hurt when an insurance company denies your claim or a request for medical care. It can seem crazy that an insurance company can deny something you really need and your doctor recommends.

We know understanding health insurance is often difficult even under the best of circumstances. When you add a difficult medical condition, an uncommon treatment or other conditions, it can seem like a maze you’ll never figure out. It also feels at times like the insurance company has stacked the odds against you. However, it’s often not as bad as it looks. The challenge is the insurance company has much more experience at dealing with claims and appeals than any policy holder. You might do one appeal in your lifetime; insurance companies do thousands a day. We work to balance the odds and streamline that difficult process by working on your behalf.

As patient advocates, we fight to clarify diagnosis and treatment options, help you understand medical options, access to quality healthcare, negotiate coverage with health insurers and providers, communicate constructively with employers, find financing options, coordinate with healthcare and other service providers; and build our clients personal advocacy skills, as needed.

Whom do we serve?

We serve patients with life-threatening and serious illnesses and their families.

What do we do?

When a prospective client contacts us, it is because they are experiencing an illness or injury and need guidance to sort out and navigate the medical and health insurance mazes. We know how to find the language in your health insurance coverage the insurance company may have overlooked or even ignored. We know what questions to ask and how to ask them in ways that unveil the real reason the insurance company denied your claim or request for benefits. We know how to talk with insurance company staff to create a path to get your benefits approved, and, importantly, we succeed at it.

Helping you find the best doctors and hospitals for your medical condition.

Coordinating hospital admissions and continuity or care arrangements for you.

Negotiating with your insurance company or companies for benefits for the treatment you need.

Negotiating with your provider to accept your benefits or other financial arrangements.

How much will it cost?

We offer fixed cost services in most cases. Please note that the fees described below are for a standard services program and may vary if your situation involves special circumstances or services. In those cases, we still offer fixed cost programs, but the amounts may differ from our standard package rate.

Health Insurance Evaluation – $800This initial service involves talking with you and looking at the terms and conditions of your health insurance policy, denials from your insurance company and other documents that are relevant to your personal situation. After this review, we discuss with you the potential for success of further efforts on your behalf. If we believe you have a strong potential for getting insurance coverage for your situation, we’ll tell you. We’ll also tell you if we think your chances are not strong. With that information, you can make an informed decision about what to do next.

Insurance Coverage Advocacy – $2,000 for a standard programSoter Healthcare begins with a deep understanding of your individual health insurance plan, since each plan has its own specific terms and conditions. We engage your insurance company, so that you can understand not only what they company decided regarding its benefit decision but why that decision was made. We obtain complete copies of your file, as warranted, from the insurance company. We question your insurance company, negotiate with them for the benefits for which you are eligible, and submit appeals to the insurance company and external review organizations. We also engage regulatory agencies when they can help with your case.

Additional Fees

Additional fees are rare; however, they do happen at times. As an example, we are typically able to send appeal documentation electronically. If that is not possible, we will bill the costs of producing and submitting paper copies. We will make every effort to make you aware of these expenses ahead of time.